More on Complex PTSD

I check my stats page for this blog every day, and when I check, I look to see which articles seem to be most popular.  So far, the article titled “Complex PTSD: Does It Exist?” has been read more times than the others.  When I wrote the article, I didn’t expect it to be this popular.  In fact, I wasn’t sure that anyone would want to read it because it struck me as being somewhat dry and academic.  However, now I know that the topic appeals to you, my readers, and I will do my best to address the topic more often.  In the meantime, here are two articles I found recently which you might find helpful:
 
• http://knowledgex.camh.net/amhspecialists/specialized_treatment/trauma_treatment/first_stage_trauma/FirstStageTT_ch6/Pages/criteria_complex_ptsd.aspx
• http://drkathleenyoung.wordpress.com/2010/03/10/complex-ptsd/


If you read the two articles listed above, you will have a good idea as to the hallmarks of C-PTSD.  You will, at least, have a good idea as to the nature of C-PTSD as the practitioners and researchers see it.  You may not, however, get much of an idea from the articles as to how the problem appears to those who live with the disorder every day—those of us who find ourselves in a C-PTSD cage and are trying to get out and join the rest of the world.

Each person who battles C-PTSD experiences the disorder differently because each person is uniquely different from any other person.  Thus, when you read my description of my experience in the articles I’ve written for this blog, it’s important to remember that my experience of C-PTSD is unique to me.  There are, though, certain common threads that run through the tapestry of each person’s experience of the disorder.

One such thread is the presence of typical PTSD symptoms—flashbacks, dissociative episodes, numbing of emotions, etc.  The presence of these symptoms has interfered with my life to the point where I have long known I needed and wanted to do something to alleviate them.  That’s the main reason why I am presently in therapy, and it’s the main reason why I have attempted to get help in the past.  At present, I can say that I have actually tamed the symptoms to the point where they don’t bother me every day, and I can ride public transportation without being knocked off kilter by the symptoms.  Possibly, if I had the “non-C” PTSD, I would be finished with therapy by now.  I would be thrilled if I were ready to leave therapy because therapy is hard work that takes a lot of my time and thought.  That time, however, has not yet arrived.  I know it will arrive someday, but it is not here yet.

The problem is that C-PTSD is, as the name says, “complex.”  If my parents had wanted me, had been understanding and nurturing and had listened to me with empathy when I was a child, and if I had grown to be a mature adult with all the attributes of an emotionally mature adult and had been raped one night when I was in the wrong place at the wrong time, then very possibly I would have been diagnosed with PTSD.  I probably could have finished therapy a long time ago because I would have had sufficient ego strength to go through a course of EMDR or one of the other therapies found effective for healing PTSD.  I don’t know this for certain, but it’s likely.
 
In my case, though, the factors mentioned above did not apply to me.  I was not wanted, was not understood, was not given the parental attention I needed, was not treated with respect, and was sexually abused and abused in other ways.  When I reached the age of adulthood, I did not have the ego strength I needed to be an effective and mature adult.  And then I married a man who continued the treatment my parents gave me.  So over a long period of time, forty-two years in my case, I endured the sort of treatment that leads to C-PTSD and thought my life was normal, that every woman endured what I endured and that there was no alternative. The threads of prolonged exposure to abuse and neglect run through my tapestry as they run through the tapestries of most others who are trapped in C-PTSD.  The material from which the threads in my tapestry are spun may not be identical to that of other people who have C-PTSD, but the basic threads themselves are present.
 
So what, in my opinion, is the most telling factor, the factor that brings me up short and causes me to recognize and acknowledge the C-PTSD elephant in my own living room?  It’s the seemingly interminable nature of the healing process.  Like Sisyphus, I roll the stone almost to the top and think, “Success!  I’m there!” only to stand with mouth agape in amazement as I watch the stone roll back down and wait for me to roll it uphill again.  I manage to reduce the intensity of my PTSD symptoms, for example, only to discover in the process that I have some developmental gap that I need to investigate, understand, and fill if I am to truly enjoy relief from my symptoms. The process doesn’t seem to end, and that fact tells me that I’m dealing with C-PTSD and not the “non-C” PTSD.
  
If the process of breaking out of the C-PTSD cage seems so interminable and is so discouraging, why do I continue trying?  I continue because as I work in therapy, the bars are beginning to become less rigid and more flexible.  For example, I can sit on a bus calmly and without dissociating now when somebody gets on, tries to avoid paying the fare, and then argues loudly with the driver.  I may become irritated at the delay and the fact that somebody is so crass as to attempt to bully the driver into letting him ride free, but I don’t let the voices raised in anger and the menacing or threatening demeanor of the bully allow PTSD symptoms to take over my mind as I would have done a year ago.  My present response to a situation that in the past would have laid me low for the better part of a day tells me that slowly the cage bars are weakening and freedom is possible.  The little signs of progress comprise the carrot on the stick that causes me to plod along toward my goal, in other words.

What would I suggest a person have available to aid in his or her escape from the cage of C-PTSD?  Here is my list of necessary equipment:

• A realistic VISION of what life may be like without the present constraints of C-PTSD;
• The necessary RELATIONSHIP with a therapist who specializes in trauma work;
• The MOTIVATION to do the job;
• COMMITMENT to one’s self and to one’s goal;
• A RECOGNITION of one’s progress, no matter how tiny the increment;
• The HOPE that springs from recognizing progress;
• A sense of HUMOR to help get one’s perspective back when times are bleakest;
• The FAITH in the process needed to keep plodding along no matter what!
 
The above is my list.  You will have your own list, no doubt, but maybe my list will remind you of something you forgot to put on your list.  And my list above may not contain everything I need, but it does contain the equipment most important to me right now. 

To conclude, I’m no learned expert on C-PTSD.  I’m not a trained mental health professional—I have a graduate degree in adult education and a graduate degree in rhetoric, neither of which qualifies me as an expert on C-PTSD.  I do, however, have something many of the experts may lack, a diagnosis of C-PTSD, and that diagnosis places me on the inside of the cage looking out.  I hope that whatever I say to you as I write “from the inside out” is useful and inspiring and facilitates your rending the bars of your cage and making your way to freedom. 

Another Way to Look at EMDR

On November 14th, I discussed my feelings regarding my “failure” to be ready for an EMDR session.  As you may be aware, I have spent almost thirty years trying to find a therapist with the training and desire to help me relieve my PTSD symptoms.  If you are struggling with the same symptoms, you understand how the flashbacks, numbing, dissociative episodes, and all the other hallmarks of PTSD can disrupt your life and damage your relationships.  Thus, you can also understand why I am highly motivated to do the work now that I have a competent therapist who is trained to facilitate trauma work.  After all, I am seventy-two years old, and I want to get the job done while I have some life left!

The problem is that at times my desire to do the work and to do it quickly makes me impatient and causes me to be a real “Debbie Downer” to myself.  Then I need a couple of days to recover my perspective on the situation.  Usually, I process this sort of thing while I sleep, and this incident is no exception, for I awoke this morning thinking of  EMDR differently from the way I had thought about it on Monday, the 14th.  On that day, I was thinking only of EMDR as a means for reprocessing trauma energy, and I was remembering the horrible reaction I had to an EMDR session during the time I saw my previous therapist (see “Why Take the Time to Prepare for EMDR?”, November 8th).  When I awoke this morning, I remembered that EMDR can also be used to install resources serving to strengthen the ego and help prepare a person for the reprocessing experience.  As I see it now, installing resources is a totally nonthreatening experience, something to anticipate with pleasure.  At least, I anticipate the experience with pleasure—I want to feel better!

How does one install a resource using EMDR?  I’ve read various articles, including one by Shirley Jean Schmidt (http://www.dnmsinstitute.com/doc/rf-emdr.pdf) discussing the use of EMDR to install resources, and perhaps the information that I stored in my brain from my reading somehow connected last night with the questions arising from the distress I experienced on the 14th.  According to Shirley Jean Schmidt, one installs resources by bilateral stimulation just as one deals with trauma memories by bilateral stimulation.  For example, on last Monday if I had drawn a picture showing the satisfaction I had felt at some point in my life when I had succeeded in mastering an important task or skill, then I would have kept that picture and the emotion and thought behind it in mind as I either did the bilateral eye movements or did bilateral tapping on my knees.  In theory, then, if I had done that last Monday, I would probably feel less threatened at a later time by the task of using EMDR to process a memory associated with trauma.
 
To me, therapy is a process, but it is also a task, one that I am attempting to complete in order to improve the quality of my life. While I know that I may not accomplish this task completely before I die, I want to work hard to accomplish as much as I can so that I can enjoy more serenity and peace of mind in my last years.  Also, I divide the general task of going through therapy into a number of subtasks, EMDR being one of those subtasks.  Therefore, to me it is perfectly logical to believe that if I have achieved good results and attained satisfaction when I have accomplished other major tasks at other times in my life, I can at some point in the future look forward to experiencing satisfaction when I use EMDR to reprocess trauma memories. 

So guess what I am going to discuss with my therapist this coming Monday, November 21st!  Right!  I am going to propose that we install a few resources that will take away some of the fear I have of reprocessing a trauma memory via EMDR!  More coming on this topic at a later date.

November 14: Today's Work . . .

As I mentioned in my post titled "Coming This Week . . . ," I needed to deal with my anxiety today, and I didn't get to the EMDR.  Today was hard for me because I had expected to get some significant EMDR work done.  It didn't happen.  So I am disappointed in myself.  However, as my therapist said, my work is just going to take a little longer.  I need to be patient with myself. 

Complex PTSD is just that:  Complex!  And it takes longer to deal with something that is complex than it does to deal with something that isn't so complex.  For more information on this, see the essay on this blog titled "Complex PTSD:  Does It Exist?" 

Knowing the above does not make me feel better about the fact that I didn't get any EMDR work done today, but on the way home, I distracted myself from the feeling of failure by treating myself to a much-needed pair of new athletic shoes--and they were on sale for $44!  So something good happened, and for that, I am grateful. 

Appreciate the little pleasures in life, for they can cushion the bumps and help you keep your perspective.

More news as time passes . . .        

Coming this week . . .

If possible, I'll diary my experience in EMDR, starting later today, so that those of you who may be interested in utilizing this mode of healing can get some idea as to how it works. 

I will admit to being a wee bit anxious about my upcoming EMDR session because the last one was so problematic--see last week's post.  However, my present therapist knows what she is doing and firmly believes and practices the principle of "First, do no harm."  If my anxiety level increases today, we may spend the time dealing with that rather than working with EMDR. 

For a few weeks, then, I'll attempt to diary my experiences so that you can get a sense of how EMDR is affecting me.  We are each different, however, so the effect EMDR has on me may be way different from the effect on you.  But I believe that there are certain common threads that run through each person's experience.  If this is true, then what I have to say may be of use to you.  Jean

Why Take the Time to Prepare for EMDR?

As you know, if you have been following my blog, the goal driving my therapy has been that of alleviating my PTSD symptoms.  About two years ago, my PTSD symptoms, after having lain somewhat dormant for about ten years, came back with a vengeance.  It’s not as if I had been ignoring my psyche and not dealing with the dissociative episodes, the flashbacks, the numbing, and all the other classic symptoms of PTSD for the past thirty years.  Not at all.  Over the past thirty years, I’ve seen a number of therapists and have spent a lot of money and about twelve years of my life trying to do something about the mess in my head.  (For more on this, please read the other articles archived on this blog.)  Unfortunately, despite my efforts, I had not found a therapist who specialized in helping people heal from trauma damage until fairly recently.  Now I am seeing such a person and am getting the job done.

After spending about eighteen months doing ego state therapy work, I am finally approaching the next phase in my therapy:  EMDR (Eye Movement Desensitization and Reprocessing).  The work in ego state therapy has prepared me for the EMDR, and now I am ready to make the transition.  Of course, I keep in mind the fact that progress in therapy, like progress in life in general, does not run in a straight line.  Progress in ego state therapy has been a dance called the “two step”—two steps back and one step forward.  However, I now have identified the parts that inhabit my psyche and seem to be most influential in their influence on my thoughts, feelings, and behavior.  More parts may announce themselves as I continue in therapy, but the parts of which I am now aware are working well together, helping one another, cooperating, and generally being friendly and supportive to one another. 

Instilling a spirit of cooperation among the parts inhabiting the psyche is fundamental to laying the basis for EMDR work, as is instilling resources or strengths in the psyche.  If this isn’t done, an EMDR session in the afternoon can result in a horrible, awful reaction in the evening. 

My previous therapist had, unfortunately, taken a shortcut with the preparation, having done virtually no ego-strengthening work with me.  One afternoon after I had been seeing her for about six months, she had me do a written dialogue between my left hand and my right hand, a powerful technique used to get in contact with one’s right brain, the side of the brain containing, among other things, emotional memories and memories of awful and traumatic events in one’s life.  After I had done this dialog and had explained the dialog to the therapist,  she clapped the EMDR apparatus on me and left it for a long time.

By the time I departed for home, I felt disoriented and spacey, and after I arrived home, I felt panicked and anxious, two feelings which became more intense as the afternoon and evening wore on.  And then it happened—I had a full-blown reaction, call it an abreaction or a flashback, whatever—and I was scared!  The reaction was directly connected to the material I had generated in the afternoon’s non-dominant hand dialog, and this material was not the stuff of which lovely, wonderful, and happy memories are made.  No, this material was the stuff of which nightmares are made and the stuff which drives some women to escape their husbands and other women to sacrifice themselves and become sexual slaves to their husbands.  Some people still do not believe that there is such a thing as marital rape.  I can tell those people a thing or two about marital rape that might make believers of them!  And on that afternoon, I relived just one episode of many episodes of marital rape during my twenty-year marriage.  The fact that this particular instance of marital rape took place in the kitchen when at least one of my children was present intensified my reaction, I’m sure.

When the reaction had run its course, I was frightened and disoriented, more fragmented by far than I had been before the EMDR experience.  I called my therapist, but she said there was nothing she could do for me.  She did suggest I use self-soothing techniques, but since I had never been taught to self-soothe and was not in the right frame of mind to learn by Googling, I hung up, knowing that the job of getting myself gathered up and re-oriented was mine and mine alone.  This was on Monday.  By Thursday I was sufficiently present in my body to leave my apartment and seek some help.  I found this help in the form of a young Episcopal priest, and by the time I left him, I was ready to take the next step, that of finding another therapist!  Every so often, I think about this experience and wonder if other clients of that therapist are experiencing a nightmare similar to mine. If they are, I hope they, too, find another therapist.

Because I am not easily deterred from a path that I consider essential, I did not give up the search for a therapist who could help me alleviate my PTSD symptoms.  And now, as I have mentioned, after spending about a year and a half preparing for EMDR, I am ready to take the next step and do it!  I know there is the possibility that despite the careful preparation, I can have a bad reaction to the therapy, but I also know that my present therapist will be there for me if I do.  I also know that she will do all within her power to minimize the chance that I will have a bad reaction.  Of that, I am confident. 

Why, after such a horrible experience with my previous therapist, do I believe EMDR is worth doing?  For one thing, despite the bad experience I had, I know EMDR works.  I can now remember the instance of marital rape I re-experienced that Monday after the EMDR treatment, and the memory no longer carries with it the full emotional charge.  Also, in about 1994 another therapist had successfully used EMDR with me to discharge the energy from another traumatic experience.  So I know EMDR does what the folks at the EMDR Institute claim it does, and because I want to do all I can to prevent sliding back into the pit of having my life disrupted by PTSD symptoms, I will give my best efforts to EMDR therapy. 

For more information on EMDR and to see if it’s something that might help you, please read the material on the official website:  www.emdr.com.